血清甲胎蛋白用于慢性肝病患者肝细胞癌的诊断：乙肝表面抗原和抗丙型肝炎病毒状态的影响

Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status.

作者信息

Trevisani F, D'Intino P E, Morselli-Labate A M, Mazzella G, Accogli E, Caraceni P, Domenicali M, De Notariis S, Roda E, Bernardi M

机构信息

Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, University of Bologna, Italy.

出版信息

J Hepatol. 2001 Apr;34(4):570-5. doi: 10.1016/s0168-8278(00)00053-2.

DOI:10.1016/s0168-8278(00)00053-2

PMID:11394657

Abstract

BACKGROUND

It is not established whether virological status affects the efficiency of alpha-fetoprotein (AFP) as a hepatocellular carcinoma (HCC) marker among patients with chronic liver disease (CLD).

METHODS

We enrolled in a case-control study 170 HCC and 170 CLD patients, matched for age, sex, CLD and HBsAg/anti-HCV status. The AFP sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. PPV and NPV were evaluated for three additional HCC prevalences (5, 10, and 20%).

RESULTS

The best discriminating AFP value was 16 ng/ml. A value of 20 ng/ml (above which investigations for HCC are recommended) had equivalent sensitivity (60.0 vs. 62.4%) and specificity (90.6 vs. 89.4%). PPV of 20 ng/ml was 84.6% but decreased to 25.1% at 5% tumor prevalence. NPV was 69.4% and rose to 97.7% at 5% prevalence. In the different groups of infected patients PPV ranged from 80.0 to 90.9%, falling to 17.4-34.5% at 5% prevalence. In noninfected patients PPV was 100% at any HCC prevalence. NPV ranged from 59.0 to 73.0%, reaching 96.5-98.1% at 5% prevalence.

CONCLUSIONS

In CLD patients, AFP monitoring misses many HCCs and inappropriately arouses suspicion of malignancy in many patients. Its usefulness is barely affected by the infection responsible for CLD. An AFP elevation could be more indicative of HCC in non-infected patients.

摘要

背景

在慢性肝病（CLD）患者中，病毒学状态是否会影响甲胎蛋白（AFP）作为肝细胞癌（HCC）标志物的有效性尚未明确。

方法

我们开展了一项病例对照研究，纳入了170例HCC患者和170例CLD患者，这些患者在年龄、性别、CLD以及乙肝表面抗原/抗丙肝病毒状态方面相互匹配。计算了AFP的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。针对另外三种HCC患病率（5%、10%和20%）评估了PPV和NPV。

结果

最佳鉴别AFP值为16纳克/毫升。20纳克/毫升的值（高于此值建议对HCC进行检查）具有相当的敏感性（分别为60.0%和62.4%）和特异性（分别为90.6%和89.4%）。20纳克/毫升的PPV为84.6%，但在肿瘤患病率为5%时降至25.1%。NPV为69.4%，在患病率为5%时升至97.7%。在不同感染患者组中，PPV范围为80.0%至90.9%，在患病率为5%时降至17.4%至34.5%。在未感染患者中，任何HCC患病率下PPV均为100%。NPV范围为59.0%至73.0%，在患病率为5%时达到96.5%至98.1%。